There was a splash of acquiescent, fawning media at the Greensboro News and Record and the Triad Business Journal regarding the fact that the takeover of Cone Health by Risant Health has been consummated.
The big theme being pushed is the fact that Cone Health will be diving headlong into “value based care” as a consequence of its takeover by Risant.
Having practiced medicine for 35 years, I have seen various administrative fads within the healthcare industry come and go. “Value based care” is the latest flavor-of-the-month.
What is this?
It is a type of insurance product that the hospital systems like Cone and Risant are eager to embrace. Private health insurance and various Medicare products are the most likely candidates to jump on this bandwagon.
The hospital system is rewarded when it develops, enforces and/or acquiesces with plans to withhold evaluating and treating patients for given medical conditions. Alternatively, one can justifiably perceive that the hospital system is penalized when these plans are violated or not developed.
Let’s say the patient has hypertension. The protocol says you must use drug A, B or C. Drug D might be better for this particular patient, but if you use it, the hospital system is penalized financially.
This type of arrangement is obviously very bad for the patient because the best treatment for his condition is more likely to be withheld. And he or she might not even know it is happening.
But there is one other twist. Under this type of arrangement, enormous pressure is brought to bear on the physician or other provider to prescribe drug A, B or C. If he does not, he will face enormous problems from the standpoint of his employment. He becomes persona non grata within the system. He gets pushed out. He doesn’t get raises. His work life is made miserable.
But for the hospital system executives, value based care will help them control local healthcare markets, further build their empires, and continue to pay themselves 7 figures.
Value based care is a form of centrally directed health care– i.e., care directed by governmental entities, insurance companies and/or hospital systems. We had a huge taste of centrally directed health care during Covid when governmental agencies and hospital systems conspired to force certain types of care on patients, and to withhold other types of care– all with disastrous results. Nearly every hospital system participated in this outrageous scheme.
That entire episode ought to make us very skeptical of centrally directed care. We have seen how it behaves during the Covid mess, and the wreckage it causes.
Simply put, value based care is a very bad deal for the patient. It is a very bad deal for physicians and other “providers”. But it is a great deal for the executive/managerial class within hospital systems. View the takeover of Cone Health by Risant with intense reservation and skepticism.
What a corporatist/fascist medical system looks like. Independence of thought by doctors eroded and the interests of the customer comes last. The heavy hand of the regulatory state (married in effect to these large corporations) enables this, preventing the corrective competition that would occur in a free country.
Government is certainly encouraging this mess, Healey; and in many cases, the insurance companies like BCBS are also instigating it. And as you say, it is a corporatist/fascist set-up with the huge hospital systems eager to participate.
In the future, history will judge our responsiveness and our ability to navigate the pandemic crisis. It will solely depend on timely and appropriate decisions made. Ethics-based decision-making should underpin our moral purposes to place us on the right side of history.
I expect Cone might not come out smelling like roses, Fred.